Citation Nr: 21077647 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 16-25 409 DATE: December 30, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from September 2001 to July 2002, from June 2003 to September 2003, from November 2003 to April 2004, from June 2004 to September 2004, from October 2004 to September 2006, and from March 2007 to November 2007. He also had many years of reserve service. His decorations include the Global War on Terrorism Expeditionary Medal, the Air Force Commendation Medal, and the Meritorious Service Medal with three Oak Leaf Clusters. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Newark, New Jersey. In August 2019, the Veteran testified at a Board video-conference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. The issue on appeal was previously before the Board in December 2019 and June 2021. On both occasions, it was remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. Although the Board regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim and to afford him every possible consideration. Service connection for sleep apnea is remanded. The Veteran seeks to establish service connection for sleep apnea. He asserts that the condition began in service. He contends that his service colleagues complained to him regarding his snoring during service. See, e.g., August 2019 Board hearing transcript. Alternatively, he asserts that his sleep apnea is related to his PTSD. The June 2021 Board remand requested, in pertinent part, that the AOJ obtain an addendum opinion as to whether the Veteran's sleep apnea began in service or was otherwise related to service. The examiner was requested to address the Veteran's assertion that his service colleagues complained to him regarding his snoring during service. A July 2021 VA examiner opined that the Veteran's sleep apnea was less likely than not incurred or caused by the claimed in-service injury, event, or illness. The examiner reasoned that while the Veteran noted that his colleagues complained to him regarding his snoring during service at his August 2019 Board hearing, the Veteran denied snoring or stopping breathing during his sleep disorder consult on December 31, 2014. It was also noted that on November 17, 2014, the Veteran reported being informed by his spouse that he snored, "which he hadn't realized." The Board finds that the July 2021 VA examiner's opinion with regard to direct service connection is inadequate. The examiner apparently dismissed the Veteran's report that his colleagues complained of his snoring during service, on the basis that the Veteran denied snoring or stopping breathing during his sleep disorder consult in December 2014. In the Board's view, the Veteran's denial of snoring in December 2014, after both his colleagues and his spouse had earlier complained of his snoring, does not necessarily negate the fact that there were complaints about snoring during service. The Veteran is competent to relate events that he has personally observed, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), and the Board has no reason on the current record to doubt the credibility of his statement regarding what others have reported to him. Because the July 2021 examiner's opinion appears to have been based, in part, on a rejection of that evidence, further development is warranted. As to secondary service connection, the Board notes that chronic sleep impairment has been noted as a symptom of the Veteran's service-connected PTSD. The evidence reflects that he takes medication to help him sleep. Thus far, no opinion has been offered with respect to whether the medication he takes for PTSD/sleep has an impact on his sleep apnea. That needs to be explored. This matter is REMANDED for the following action: 1. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. After the foregoing development has been completed to the extent possible, arrange to have a qualified clinician review the claims file for purposes of providing an addendum medical opinion with respect to the etiology of the Veteran's sleep apnea. After reviewing the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran's sleep apnea had its onset in, or is otherwise attributable to, his periods of active service. In so doing, the examiner must consider and discuss the medical significance, if any, of the Veteran's assertions that his service colleagues complained to him regarding his snoring during service. For purposes of the examiner's assessment, it should be presumed that that statement is true. If it is the examiner's conclusion that it is unlikely that the Veteran's sleep apnea is attributable to service, the examiner should offer a further opinion as to whether it is at least as likely as not that the Veteran's sleep apnea has been (a) caused or (b) aggravated (i.e., permanently or temporarily worsened beyond natural progression) by his service-connected PTSD, to include as a result of any medication taken for treatment of PTSD. A complete medical rationale for all opinions expressed must be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issue on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph T. Leonard, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.